Intraparenchymal Cyst Development after Deep Brain Stimulator Placement

Abstract

Following deep brain stimulation (DBS) surgery, a variety of potential mechanical or functional complications ranging from perioperative events to hardware malfunction may occur. We present 2 patients who developed a unique complication of cyst formation at the tip of the DBS electrode in the absence of infection. One patient had a unilateral ventral intermediate lead placement for essential tremor, and the other had bilateral subthalamic nucleus (STN) placement for Parkinson's disease. After a period of symptom control, at 3 and 8 months after surgery, respectively, both patients developed new neurological deficits and were found to have a cyst at the left DBS lead tip. The right lead in the patient with the bilateral STN implant was without issue. Both affected leads were removed and the problematic symptoms regressed quickly over several days, though the lesion effect on the patients' initial tremor symptoms lasted for months. Bacteriological cultures of the removed electrodes and wounds were negative. We report a rare complication of DBS and show that simply removing the involved lead results in cyst resolution.

Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson's disease

“…In subsequent reports, Ramirez-Zamora et al , in 2012, and Baxi et al , in 2014, also described intraparenchymal cyst development in patients after DBS placement. The former report included two patients who developed neurological deficits over a time period of 3–6 months, where the cyst formation was limited to the tip of the DBS electrode 9. The latter report described two patients who were incidentally found to have asymptomatic non-infectious cysts, also mostly located at the tip of the electrode lead 8.…”

Cystic Lesions as a Rare Complication of Deep Brain Stimulation

“…Both cysts resolved after removal of the DBS lead. These investigators suggested that the cause of cyst formation was tracked CSF during placement of the DBS lead or, alternatively, because of an autoimmune or inflammatory response to the DBS hardware …”

“…These investigators suggested that the cause of cyst formation was tracked CSF during placement of the DBS lead or, alternatively, because of an autoimmune or inflammatory response to the DBS hardware. 4,5 Acute brain parenchymal reaction resulting from lead insertion has been suggested as a mechanism for rare findings of low-attenuation signal around the DBS lead after surgery by Kim et al 6 They described 7 cases of transient increased lowattenuation signals that circumferentially surrounded DBS electrodes. The signal extended into the subcortical white matter and was associated with unexpected and transient neurological symptoms during the immediate postoperative period.…”

Deep brain stimulation and intracerebral infection: A case report and review of the literature

“…Ramirez‐Zamora recently presented two cases of intraparenchymal cysts after DBS surgery. This is also a rare complication that can be clinically difficult to differentiate from delayed intracerebral electrode infection . The best radiological follow up for diagnosis of abscess or edema along the electrodes is MRI, which can be safely carried out with the stimulator off in a 1.5 T camera.…”